A Care Workers’ Revolution

…and visit which is
mounting a green paper campaign in tandem with this series of
articles, including an online discussion forum for all our readers
to air their views on each week’s theme. We will compile your
views into a report to be discussed at our green paper conference,
Power to the People: Will the adult green paper deliver?, taking
place in London on 27 June. New workforce roles raise many
questions. Tell us what you think.

About the panel

Our panellists are drawn from the Inter-Agency Group on the green
paper, a coalition set up to analyse the impact of government
policy on adult social care.

John Dixon, Association of Directors of Social
Services’ disabilities committee

“
The new roles referred to in the green paper are potentially
confusing: care navigators, care brokers, along with the existing
care managers. And who is best placed to carry out these tasks? A
local authority social worker? An independent? The service
users themselves? We need to build on best practice in developing
self-assessment and service users may need help to find their way
around (from a “navigator”): here, knowledge of the
system is the prerequisite and some service users may also prefer
this person to be independent of the local authority.

There will always come a time when an assessment with significant
funding implications needs to be matched with needs-based criteria
and that is a role for a care manager.

But there is also a role for independent care brokerage. West
Sussex buys only about one fifth of its formal care provision; the
rest is paid by service users and their families. Often these
decisions, with their life-changing consequences, are made with
little or no advice. If those people were buying a financial
product they might well go to a financial adviser. Why not go to a
care adviser or broker for this even more important
decision?

The green paper lays great stress on the need for a change of
culture as well as improved leadership. But staff should find it
gives them a chance to do what they came into the job for in the
first place. The gatekeeping process removes social workers from
personal contact with clients and submerges them with
paperwork.

We’re running a project at our help desk in Chichester,
returning control over workflows in referrals and intake to the
social workers. Staff who were desk-bound are now able to go out
and make personal assessment visits.

The results have been startling – the proportion of cases resolved
satisfactorily at first contact jumped from 46 per cent to 82 per
cent.”

Jeni Bremner, programme director, education and social
policy, Local Government Association

“
The green paper must be seen alongside the children’s
workforce strategy published by the Department for Education and
Skills. A key role for both the new directors of children’s
services and the directors of adult services is working together to
plan and develop the workforce. Many of the skills are transferable
between adults and children’s services.

And, as children are cared for by adults, child protection will
remain an issue for adult services. Staff in both adult and
children’s services will be working with families and
communities and there are the issues of transition between services
to support children and young people to services for
adults.

Directors of adult and children’s services will also need
real joint working arrangements with local health organisations as
actions in one part of the system will have knock-on effects in
other parts of the system.

At the centre of the green paper workforce agenda is social work.
Care navigators, care brokers, person-centred planning facilitators
and care managers are roles currently carried out by social
workers. Social workers are at the heart of joining up care across
different sectors and professional groups and we must continue the
work to support and develop this essential profession.

The quality of our services is dependent on our workforce. Building
its capacity will require real investment in training. In such a
workforce intensive sector that will not be cheap. The current
level of investment is welcome but without further sustained
investment in training and development across the social care
workforce, the green paper cannot be delivered.”

Jo Webber, policy manager, NHS Confederation

“
If care navigators and planning facilitators are to be introduced,
isn’t there a danger that current working relationships
between health and social care at operational level will be
upset?

The challenge will be to manage this transition so that integrated
care between the professionals working in health and social care
sectors is maintained and enhanced.

Care navigation should be part of the skills of all primary care
professionals. But perhaps this role has been lost as our services
provide ever-increasing services within the same finite
resources.

The navigator or manager of care for an individual person could be
a community nurse or matron, a social worker, a health care
assistant or care assistant – it is the role and the skill, not the
title that is attached to it, that matters. And where will these
new staff come from in a system that already struggles to attract
recruits?

The status of the social care profession and staff morale needs to
be addressed as a matter of urgency by the government –
that’s the key to the current recruitment and retention
challenge.

At the level of care worker and health care assistant there needs
to be investment and development just as much as for the more
senior grades.

We would like to see better cross-agency shared training, both
before and after registration, and we would also like to see the
government actively investigating the possibility of shared
registration. This could lead to better integration and movement of
staff across care boundaries so that we can break out of our
individual silos, not develop a new one with more jargon-laden
titles. ”

Heléna Herklots, head of policy, Age Concern
England

“
There are more than one million people working in social care and
more than half work in the private sector. A trained and supported
workforce, with appropriate recognition and status, is crucial for
getting the right services and outcomes for social care
users.

The green paper puts forward a number of suggestions of key roles
to help and support users. These include care navigators,
person-centred planning facilitators and care brokers. These roles
reflect both the aspirations of the green paper – to give users
more choice and control and the support to exercise this; and the
implicit acknowledgement that the social care system is so complex
that it is almost impossible to navigate it successfully on
one’s own. So, care navigators could have an important role
to play. But the green paper has missed an opportunity to look at
simplifying the system for those who use it and those who work in
it.

The green paper also ducks the issue of funding, which has a direct
bearing on the social care workforce. Without adequate funding for
social care the well documented workforce problems – recruitment
difficulties, high vacancy rates and retention problems – are going
to continue. And an ageing society makes it increasingly important
to recruit, retain and support older workers.

Volunteers get a mention but their vital role in social care, and
their importance for its future success, is underplayed. Carers are
also acknowledged but the green paper should place more emphasis on
their support, including making training much more widely
available. Finally, the need for the workforce, in whatever sector
or role, to work across boundaries and work effectively with
different disciplines must be further encouraged and
supported.”

Angela Greatley, chief
executive, Sainsbury Centre for Mental Health

“
The challenge of creating a new social care workforce is similar to
that facing the NHS. Efforts to boost the NHS mental health
workforce have concentrated on recruitment and retention, tackling
some growing problems with an ageing staff profile. These are
problems for social care too. What is clear is that doing more of
the same in either health or social care will not fill the growing
gap. We need a new kind of recruit.

The green paper is strong in identifying leadership and the need to
stimulate the voluntary, community and private sectors. It is also
strong in identifying the potential for community support and
volunteering alongside the more specialised social and healthcare
sectors.

But both health and social care are still a long way from knowing
how they are going to attract recruits from outside the traditional
professional routes and from a wider range of cultures and
backgrounds and provide them with the knowledge and skills to do
the job. Whatever approach they take, the two sectors have to work
together to avoid robbing Peter to pay Paul by competing for a
diminishing pool of recruits.

We also need to avoid re-inventing wheels. Mental health has some
long – and not altogether successful – experience of roles like
that of the proposed care navigator and of advocates. It will be a
challenge to get people to do advocacy well and for navigators to
be more than care managers for mainstream services. Many staff have
these responsibilities as part of their work currently. They need
acknowledgement of this role and support to develop it. A new
profession is not what is required.”

Independent View

Ray Jones, director of adult and community services,
Wiltshire Council and deputy chair, British Association of Social
Workers

“
A vote of confidence for social care workers and social workers –
that’s my reading of the green paper.

For social workers in particular there are many positive statements
about how we have, and can, contribute to assisting people to live
independently, with more choice and control, and where they
continue to play an active role in their communities.

The traditions of social work include a concern for social justice,
seeing people’s strengths and capacity as well as their
difficulties, helping people to determine their own solutions to
problems and not running away from the distress that people may be
experiencing.

As well as assisting people to shape their own pathways in a
complex world (the “care navigator” role), the quality
of the relationship between the social worker and disabled and
older person is also given prominence, with specific therapeutic
interventions being within the competence base to be used when
necessary.

This is a chance for social workers to gain the professional
recognition they deserve…let’s take it.”

Training and learning

Questions about this article to guide discussion in teams are at
www.communitycare.co.uk/prtl Individuals learning from the
discussion can be registered on a free, password-protected training
log held on the site. This is a service from Community Care for all
GSCC-registered professionals.

Abstract

In this article, leading professionals from the social care sector
look at the green paper’s proposals for the workforce. New
job roles, such as care navigators and care brokers, are examined,
along with more traditional concerns about recruitment and
retention and the training of the social care workforce.